Basic Information
| Provider Information | |||||||||
| NPI: | 1144361064 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DALY | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3425 N CARLISLE ST | ||||||||
| Address2: | 2ND FLOOR HUDSON BUILDING | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191405108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157078561 | ||||||||
| FaxNumber: | 2157073677 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 EAST LEHIGH AVENUE - DEPT. OF PSYCHOLOGY | ||||||||
| Address2: | MAB BLDG, SUITE 105 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157078496 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PS016114 | PA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.